Mental Health Bill [HL]

As we have heard, Amendment No. 9 would require all civil patients to be detained under Section 2 when first admitted to hospital. Noble Lords have spoken with great expertise and authority on this, and I understand that this is not a minor amendment. However, I should say to the noble Earl, Lord Howe, that this has nothing to do with cost-cutting. What we are talking about in the Bill is the need to ensure that patients receive the best treatment available and that we make the best use of the resources available. Of course, no patient should ever be detained without the need for detention being assessed first. Similarly, no patient should be treated without an assessment of what treatment they need. However, it does not follow that all patients who need to be detained under the Act need initially to be detained under Section 2. In fact, only around a quarter of those detained under Section 3 have been detained under Section 2 first. Many clinicians believe that Section 3 has a valid purpose as a primary form of detention in its own right. Patients who are known to mental health services and are presenting with the same symptoms as in previous episodes should be detained under the appropriate section. I hear what the noble Baroness says, but if it is known what is wrong with the patient and that ““appropriate treatment is available””, Section 3 would be the most appropriate section. The simple fact is that they do not need to be detained for assessment, and arguably the person making the application and the doctors supporting it would be forced to claim something they did not truly believe. However, I recognise and accept the point made that people may change between assessments. We could try to tackle this by making the criteria for Sections 2 and 3 the same, but that would not be right either, because there are people who need to be detained for assessment precisely because it is not clear whether they need to be detained for treatment. It must be remembered that many patients have an ongoing relationship with mental health services, and people see the changes taking place. They stay in contact with services and may admit themselves as informal patients if they feel their mental state is deteriorating. These patients will be assessed and, where necessary, treated in hospital as informal patients. But if something changes and they then require detention under the Act, it may not be necessary for them to be detained for a further assessment under Section 2. In 2004-05 some 37 per cent of detentions under Section 3 were of people already in hospital. All patients detained under the Act are continuously assessed to ensure that the initial diagnosis is still correct and that the treatment remains appropriate. Patients admitted for assessment under Section 2 can still be treated even though there is no requirement to establish that appropriate treatment is available before they are detained. Section 2 provides the right to reply to the tribunal in the first 14 days of detention, with a tribunal hearing within seven days. If the real issue behind this amendment is a desire to give all patients earlier access to a mental health review tribunal, this we believe is the wrong way to go about it. The Department for Constitutional Affairs is undertaking a series of programmes to improve the efficiency of mental health review tribunals in England and to shorten the length of time between application and tribunal hearing. In addition, the Bill provides for an order-making power that will enable the Secretary of State and the Welsh Ministers to reduce the period before a patient is referred to the tribunal by the hospital managers. Those safeguards will improve access to the tribunal. In response to the noble Earl, Lord Howe, all patients detained under Section 3 are entitled to apply to the tribunal and will receive a hearing, on average, within six weeks of applying. The noble Baroness, Lady Murphy, asked whether someone could be placed under SCT after one day in hospital under Section 3. In many ways, she answered the question herself but, of course, someone can be brought under the powers of the Act only if they meet the conditions of Section 3. It is highly unlikely that someone brought into hospital under Section 3 would qualify for that the very next day. We believe, as do many clinicians, that the current admission structure, which enables Sections 2 or 3 to be used, is the most appropriate and I therefore ask the noble Baroness to withdraw this amendment.